title: Extent of preoperative false lumen thrombosis does not influence long-term survival in patients with acute type A aortic dissection.
abstract: BACKGROUND
  Partial thrombosis of the false lumen has been related to aortic growth, reoperations, and death in the chronic phase of type B and repaired type A aortic dissections. The impact of preoperative false lumen thrombosis has not been studied previously. We used data from a contemporary, multinational database on aortic dissections to evaluate whether different degrees of preoperative false lumen thrombosis influenced long-term prognosis.
  
  
  RESULTS
  We examined the records of 522 patients with surgically treated acute type A aortic dissections who survived to discharge between 1996 and 2011. At the preoperative imaging, 414 (79.3%) patients had patent false lumens, 84 (16.1%) had partial thrombosis of the false lumen, and 24 (4.6%) had complete thrombosis of the false lumen. The annual median (interquartile range) aortic growth rates were 0.5 (-0.3 to 2.0) mm in the aortic arch, 2.0 (0.2 to 4.0) mm in the descending thoracic aorta, and similar regardless of the degree of false lumen thrombosis. The overall 5-year survival rate was 84.7%, and it was not influenced by false lumen thrombosis (P=0.86 by the log-rank test). Independent predictors of long-term mortality were age >70 years (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.20 to 4.56, P=0.012) and postoperative cerebrovascular accident, coma, and/or renal failure (HR, 2.62; 95% CI, 1.40 to 4.92, P=0.003).
  
  
  CONCLUSIONS
  Patients with acute type A aortic dissection who survive to discharge have a favorable prognosis. Preoperative false lumen thrombosis does not influence long-term mortality, reintervention rates, or aortic growth.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway.
authors.forename: Magnus
authors.initials: M
authors.lastname: Larsen
authors.forename: Kristian
authors.initials: K
authors.lastname: Bartnes
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Stuart
authors.initials: S
authors.lastname: Hutchison
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D017741:Survivors; D013927:Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: aortic dissection; prognosis; surgery; thrombosis